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Jaju A, Li Y, Dahmoush H, Gottardo NG, Laughlin S, Mirsky D, Panigrahy A, Sabin ND, Shaw D, Storm PB, Poussaint TY, Patay Z, Bhatia A. Imaging of pediatric brain tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30147. [PMID: 36519599 PMCID: PMC10466217 DOI: 10.1002/pbc.30147] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/16/2022]
Abstract
Tumors of the central nervous system are the most common solid malignancies in children and the most common cause of pediatric cancer-related mortality. Imaging plays a central role in diagnosis, staging, treatment planning, and response assessment of pediatric brain tumors. However, the substantial variability in brain tumor imaging protocols across institutions leads to variability in patient risk stratification and treatment decisions, and complicates comparisons of clinical trial results. This White Paper provides consensus-based imaging recommendations for evaluating pediatric patients with primary brain tumors. The proposed brain magnetic resonance imaging protocol recommendations balance advancements in imaging techniques with the practicality of deployment across most imaging centers.
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Affiliation(s)
- Alok Jaju
- Department of Medical Imaging, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Yi Li
- UCSF Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Hisham Dahmoush
- Department of Radiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - Nicholas G Gottardo
- Department of Paediatric and Adolescent Oncology and Haematology, Perth Children's Hospital, Brain Tumour Research Programme, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Suzanne Laughlin
- Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Noah D Sabin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Dennis Shaw
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Phillip B Storm
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Zoltan Patay
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Ackley E, Asamoah P, Mirsky D, White C, Maloney J, Stence N, Silveira L, Yonker M, Neuberger I. Dots and spots: A retrospective review of T2-hyperintense white matter lesions in pediatric patients with and without headache. Headache 2023; 63:611-620. [PMID: 37114889 DOI: 10.1111/head.14503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE We aimed to determine if T2-weighted hyperintense white matter lesions (WMLs) on brain magnetic resonance imaging (MRI) occur more frequently in pediatric patients with migraine and other primary headache disorders compared to the general pediatric population. BACKGROUND Small foci of T2 hyperintensity in the white matter are frequently identified on brain MRI during the workup of pediatric headache. Such lesions have been reported to be more common among adults with migraine versus adults without migraine; however, this association has not been well established in the pediatric population. METHODS We performed a retrospective cross-sectional single-center study of electronic medical records and radiologic studies, examining pediatric patients from 3 to 18 years old who underwent brain MRI between 2016 and 2021. Patients with existing intracranial disease or abnormalities were excluded. Patients with reports of headache were categorized. Imaging was reviewed to determine the number and location of WMLs. Headache-associated disability scores (Pediatric Migraine Disability Assessment) were noted, when available. RESULTS Brain MRI of 248 patients with a diagnosis of headache (144 with migraine, 42 with non-migraine primary headache, and 62 with headache that could not be further classified) and 490 controls were reviewed. WMLs were encountered commonly among all study participants, with a prevalence of 40.5% (17/42) to 54.1% (265/490). There was no statistically significant difference comparing the number of lesions between each of the headache groups and the control group: migraine group versus control group median [interquartile range (IQR)], 0 [0-3] versus 1 [0-4], incidence rate ratio [95% confidence interval (CI)], 0.99 [0.69-1.44], p = 0.989, non-migraine headache group versus control group median [IQR], 0 [0-3] versus 1 [0-4], 0.71 [0.46-1.31], p = 0.156, headache not otherwise specified group versus control group median [IQR], 0 [0-4] versus 1 [0-4], 0.77 [0.45-1.31], p = 0.291. There was no significant correlation between headache-associated disability and the number of WMLs (0.07 [-0.30 to 0.17], rho [95% CI]). CONCLUSION T2 hyperintense WMLs are common within the pediatric population and are not encountered more frequently in pediatric patients with migraine or other primary headache disorders. Thus, such lesions are presumably incidental and unlikely related to headache history.
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Affiliation(s)
- Elizabeth Ackley
- Department of Pediatrics (Neurology), Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Philip Asamoah
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Christina White
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - John Maloney
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Nicholas Stence
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Lori Silveira
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Colorado, Aurora, USA
| | - Marcy Yonker
- Department of Pediatrics (Neurology), Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
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Samples DC, Staulcup S, Hovis G, Gustin P, Meier M, Mirsky D, Hankinson TC. Refining the role of cervical spine immobilization and stabilization in pediatric non-accidental trauma, a retrospective series of 1008 patients. Childs Nerv Syst 2022; 38:2357-2364. [PMID: 36380050 DOI: 10.1007/s00381-022-05751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Prompt detection of traumatic cervical spine injury is important as delayed or missed diagnosis can have disastrous consequences. Given the understood mechanism of non-accidental trauma (NAT), it is reasonable to suspect that cervical spine injury can occur. Current management of young children being evaluated for NAT includes placement of a rigid collar until clinical clearance or an MRI can be obtained. Currently, there exists a lack of robust data to guide cervical bracing. Anecdotally, our group has not observed a single patient with a diagnosis of NAT who required operative stabilization for cervical spine instability. This study will be the largest series to date and aims to systematically investigate this observation to determine the likelihood that children with a diagnosis of NAT harbor cervical spine instability related to their injuries. METHODS Patient data from the Children's Hospital Colorado Trauma Registry diagnosed with non-burn-only NAT were reviewed retrospectively. Children less than 4 years of age pulled from the registry from January 1, 2005, to March 31, 2021, were included. Demographic, admission/discharge, imaging, and clinic management data were collected for each patient and analyzed. RESULTS There were 1008 patients included in the cohort. The age at presentation ranged from 5 days to 4 years (mean 10.4 months). No patient had X-ray or CT findings concerning for cervical instability. Three patients had MRI findings concerning for cervical instability. Two of these underwent external bracing, and the third died from unrelated injuries during their hospitalization. Only four patients were discharged in a cervical collar, and all were ultimately cleared from bracing. No patient underwent a spinal stabilization procedure. CONCLUSIONS While the mechanism of injury in many NAT cases would seem to make significant cervical spine injury possible, this single-center retrospective review of a large experience indicates that such injury is exceedingly rare. Further study is merited to understand the underlying pathophysiology. However, it is reasonable to consider cervical collar clearance in the setting of normal radiographs and a reassuring neurological exam. Furthermore, if concerns exist regarding cervical spine instability on MRI, an initial trial of conservative management is warranted.
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Affiliation(s)
- Derek C Samples
- Department of Neurosurgery, University of Colorado, Anschutz Medical Campus College of Medicine, Aurora, USA. .,Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA.
| | - Susan Staulcup
- Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Gabrielle Hovis
- Department of Neurosurgery, University of California Irvine, Irvine, CA, USA
| | - Paul Gustin
- Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA.,Department of Neurosurgery, Carle BroMenn Medical Center, Normal, IL, USA
| | - Maxene Meier
- Research Outcomes in Children's Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - David Mirsky
- Department of Pediatric Radiology and Imaging, Children's Hospital Colorado, Aurora, CO, USA
| | - Todd C Hankinson
- Department of Neurosurgery, University of Colorado, Anschutz Medical Campus College of Medicine, Aurora, USA.,Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
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Mastej EJ, Leppert MH, Poisson S, Ritchey Z, Barry M, Rundek T, Liebeskind DS, Mirsky D, Bernard TJ, Stence NV. Thalamic Volume Loss Is Greater in Children Than in Adults Following Middle Cerebral Artery Territory Arterial Ischemic Stroke. J Child Neurol 2022; 37:882-888. [PMID: 36069041 PMCID: PMC9560991 DOI: 10.1177/08830738221118807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Younger stroke patients may suffer worse outcomes than older patients; however, the extent to which age at stroke impacts remote areas of the brain remains unclear. The objective of this study was to determine thalamic volume changes ipsilateral to middle cerebral artery territory strokes based on age at acute ischemic stroke onset. Methods: Acute ischemic stroke patients <9 years, 9-18 years, and >18 years old were retrospectively recruited from a large quaternary care system. Each subject underwent an acute (<72 hours from AIS) and chronic (>90 days) magnetic resonance imaging (MRI) scan. Manual thalamic segmentation was performed. Results: Younger and older children had significantly greater stroke-side thalamic volume loss compared to adults (48.2%, P = .022; 40.7%, P = .044, respectively). Conclusions: Stroke-side thalamic volumes decreased across the age spectrum but to a greater degree in pediatric patients. This observation can affect functional and cognitive outcomes post stroke and warrants further research.
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Affiliation(s)
- Emily J. Mastej
- Computational Bioscience Program, University of Colorado Anschutz, Aurora, CO
| | - Michelle H. Leppert
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Sharon Poisson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Zak Ritchey
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO
| | - Megan Barry
- Section of Child Neurology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | - David S. Liebeskind
- Department of Neurology, University of California Los Angeles, Los Angeles, CA
| | - David Mirsky
- Department of Radiology, Children’s Hospital Colorado, Medicine, Aurora, CO
| | - Timothy J. Bernard
- Section of Child Neurology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Nicholas V. Stence
- Department of Radiology, Children’s Hospital Colorado, Medicine, Aurora, CO
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Tietze A, Mankad K, Lequin MH, Ivarsson L, Mirsky D, Jaju A, Kool M, Hoff KV, Bison B, Löbel U. Imaging Characteristics of CNS Neuroblastoma- FOXR2: A Retrospective and Multi-Institutional Description of 25 Cases. AJNR Am J Neuroradiol 2022; 43:1476-1480. [PMID: 36137662 PMCID: PMC9575542 DOI: 10.3174/ajnr.a7644] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE The 5th edition of the World Health Organization Classification of CNS tumors defines the CNS neuroblastoma FOXR2 in the group of embryonal tumors. Published clinical outcomes tend to suggest a favorable outcome after resection, craniospinal irradiation, and chemotherapy. This multicenter study aimed to describe imaging features of CNS neuroblastoma-FOXR2, which have been poorly characterized thus far. MATERIALS AND METHODS On the basis of a previously published cohort of tumors molecularly classified as CNS neuroblastoma-FOXR2, patients with available imaging data were identified. The imaging features on preoperative MR imaging and CT data were recorded by 8 experienced pediatric neuroradiologists in consensus review meetings. RESULTS Twenty-five patients were evaluated (13 girls; median age, 4.5 years). The tumors were often large (mean, 115 [ SD, 83] mL), showed no (24%) or limited (60%) perilesional edema, demonstrated heterogeneous enhancement, were often calcified and/or hemorrhagic (52%), were always T2WI-hyperintense to GM, and commonly had cystic and/or necrotic components (96%). The mean ADC values were low (687.8 [SD 136.3] × 10-6 mm2/s). The tumors were always supratentorial. Metastases were infrequent (20%) and, when present, were of nodular appearance and leptomeningeal. CONCLUSIONS In our cohort, CNS neuroblastoma FOXR2 tumors showed imaging features suggesting high-grade malignancy and, at the same time, showed characteristics of less aggressive behavior. There are important differential diagnoses, but the results of this study may assist in considering this diagnosis preoperatively.
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Affiliation(s)
- A Tietze
- From the Institute of Neuroradiology (A.T.)
| | - K Mankad
- Department of Radiology (K.M., U.L.), Great Ormond Street Hospital, London, UK
| | - M H Lequin
- Department of Radiology (M.H.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Ivarsson
- Department of Pediatric Radiology (L.I.), Queen Silvias Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - D Mirsky
- Department of Pediatric Radiology and Imaging (D.M.), Children's Hospital Colorado, Denver, Colorado
| | - A Jaju
- Department of Medical Imaging (A.J.), Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - M Kool
- Hopp Children's Cancer Center (M.K.), Heidelberg, Germany
- Division of Pediatric Neurooncology (M.K.), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
- Princess Máxima Center for Pediatric Oncology (M.K.), Utrecht, the Netherlands
| | - K V Hoff
- Department of Pediatric Oncology and Hematology (K.V.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - B Bison
- Department of Neuroradiology (B.B.), University Hospital Augsburg, Ausburg, Germany
| | - U Löbel
- Department of Radiology (K.M., U.L.), Great Ormond Street Hospital, London, UK
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Powers AM, White C, Neuberger I, Maloney JA, Stence NV, Mirsky D. Fetal MRI Neuroradiology: Indications. Clin Perinatol 2022; 49:573-586. [PMID: 36113923 DOI: 10.1016/j.clp.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fetal MRI is a safe, noninvasive examination of the fetus and placenta, a complement to ultrasonography. MRI provides detailed CNS evaluation, including depicting parenchymal architecture and posterior fossa morphology, and is key in prenatal assessment of spinal dysraphism, neck masses, and ventriculomegaly. Fetal MRI is typically performed after 22 weeks gestation, and ultrafast T1 and T2-weighted MRI sequences are the core of the exam, with advanced sequences such as diffusion weighted imaging used for specific questions. The fetal brain grows and develops rapidly, and familiarity with gestational age specific norms is essential to MRI interpretation.
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Affiliation(s)
- Andria M Powers
- Children's Hospital and Medical Center, University of Nebraska Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA.
| | - Christina White
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - John A Maloney
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - Nicholas V Stence
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
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Lindsay H, Massimino M, Avula S, Stivaros S, Grundy R, Metrock K, Bhatia A, Fernández-Teijeiro A, Chiapparini L, Bennett J, Wright K, Hoffman L, Smith A, Pajtler K, Poussaint TY, Warren K, Foreman N, Mirsky D. EPEN-01. Response assessment in pediatric intracranial ependymoma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION: Ependymomas remain a major cause of cancer-related death in childhood and adolescence, with recurrence occurring in up to 50% of patients. Despite exciting molecular advances in understanding ependymoma tumorigenesis and recurrence, MRI remains the mainstay for assessing objective response to therapy and duration of disease stability. Standardized response assessment criteria for clinical trials studying pediatric intracranial ependymoma are critically needed in order to accurately compare results between studies. METHODS: To generate these standardized response criteria in pediatric intracranial ependymoma, a multidisciplinary team of pediatric neuro-oncologists, neuroradiologists, neurosurgeons, radiation oncologists, and molecular biologists formed the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. The expert members reviewed relevant published literature, assessed current clinical practices, and engaged in iterative discussions to provide consensus recommendations for objective response assessment in pediatric intracranial ependymoma for use in prospective clinical trials. RECOMMENDATIONS AND CONCLUSIONS: The primary sequences for detecting and measuring disease and assessing radiologic response to therapy should be the contrast-enhanced T1-weighted sequence or T2-weighted sequence (T2 or T2-FLAIR) depending on which sequence the tumor is best visualized. When metastatic disease is present, only the three largest lesions will be followed in addition to any residual disease at the primary tumor focus. Importantly, the RAPNO working group notes that radiologic response to therapy is of limited value in clinical trials of patients with ependymoma, since most patients enroll on clinical trials with either no evidence of disease or only minimal disease. In recurrent or progressive disease that cannot be resected, true radiologic disease response to therapy is less clinically meaningful as a study endpoint than event-free and/or overall survival (representing prolonged stable disease) but may provide a signal of efficacy worthy of future exploration in patients with complete to near complete resections.
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Affiliation(s)
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumouri , Milan , Italy
| | - Shivaram Avula
- Alder Hey Children’s NHS Foundation Trust , Liverpool , United Kingdom
| | - Stavros Stivaros
- Central Manchester University Hospitals NHS Foundation Trust , Manchester , United Kingdom
- University of Manchester , Manchester , United Kingdom
| | | | - Katie Metrock
- University of Alabana at Birmingham , Birmingham, AB , USA
| | - Aashim Bhatia
- Children’s Hospital of Philadelphia , Philadelphia, PA , USA
| | | | | | | | - Karen Wright
- Dana-Farber and Boston Children’s Cancer and Blood Disorders Center , Boston, MA , USA
| | | | - Amy Smith
- Orlando Health-Arnold Palmer Hospital , Orlando, FL , USA
| | - Kristian Pajtler
- German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
- Hopp Children’s Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
| | | | - Katherine Warren
- Dana-Farber and Boston Children’s Cancer and Blood Disorders Center , Boston, MA , USA
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Dorris K, Mettetal A, Dahl N, Hemenway M, Winzent-Oonk S, Prince E, Vijmasi T, McWilliams J, Jordan K, Mirsky D, Hoffman L, Hankinson T. RARE-32. Phase 0 and feasibility single-institution clinical trial of intravenous tocilizumab for adamantinomatous craniopharyngioma. Neuro Oncol 2022. [PMCID: PMC9165090 DOI: 10.1093/neuonc/noac079.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND: Adamantinomatous craniopharyngioma (ACP) is a devastating skull-base tumor believed to derive from epithelial remnants of the primordial craniopharyngeal duct (Rathke’s pouch), which gives rise to the anterior pituitary gland. ACP lacks medical antitumor therapies. Current standard therapy with surgery and radiation is associated with poor quality of life. Clinical and preclinical data indicate that IL-6 blockade may contribute to ACP tumor control. METHODS: Children aged 2–21 years with newly diagnosed or previously treated ACP with measurable disease are eligible for the Phase 0/feasibility single-institution clinical trial (NCT03970226) of intravenous (IV) tocilizumab at Children’s Hospital Colorado. The phase I stratum involves IV tocilizumab prior to a standard-of-care surgical resection. The feasibility portion of the trial involves IV tocilizumab every two weeks for up to 13 28-day cycles. Tocilizumab is administered at the established weight-based pediatric dosage of 8 mg/kg for patients who weigh ≥30kg or 12 mg/kg for patients who weigh <30kg. RESULTS: To date, three patients have been enrolled on the Phase 0 component of the trial. These patients demonstrated clinically relevant levels of tocilizumab (≥ 4µg/mL) in serum, cyst fluid, and/or tumor tissue, compared to undetectable levels in control samples. Two patients (1 male and 1 female; median age 10.5 years) have enrolled on the feasibility stratum; one patient had best response of minor response but met definition of progressive disease at cycle 11. One patient with extensive disease required dose reduction for myelosuppression. CONCLUSION: Systemic delivery of tocilizumab at the established pediatric dosage is promising for treatment of ACP based on preclinical work and its demonstrated penetration into cystic and solid portions of ACP tumors. The therapy to date has been well tolerated overall. Further study is planned through a CONNECT consortium international Phase II trial.
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Tietze A, Lequin MH, Bison B, Ivarsson L, Mirsky D, Jaju A, Löbel U, von Hoff K, Mankad K. IMG-05 Imaging characteristics of CNS NB-FOXR2 – a retrospective and MULTI-INSTITUTIONAL DESCRIPTION OF 25 CASES. Neuro Oncol 2022. [PMCID: PMC9165182 DOI: 10.1093/neuonc/noac079.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: The CNS neuroblastoma with forkhead box R2 (CNS NB-FOXR2) activation is one of the new embryonal tumor entities in the WHO CNS tumor classification 2021. The data currently available suggest a comparably favourable outcome after craniospinal irradiation and chemotherapy. The entity is poorly characterized on imaging. We therefore aimed to describe imaging features in a multi-center patient cohort. MATERIAL AND METHODS: Molecularly and histologically confirmed CNS NB-FOXR2 tumors were retrospectively collected at six pediatric oncology centers. The imaging features on preoperative MRI and CT data were recorded by 8 experienced pediatric (neuro)radiologists in consensus. RESULTS: Twenty-five patients were identified (13 females). The majority of tumors were large at presentation (mean 115 ± SD 83 ml), showed mostly none or little perifocal edema, enhanced only partly, were often calcified and/or hemorrhagic, were always T2w hyperintense to gray matter, and often had cystic and/or necrotic components. The min. mean ADC values were relatively low (mean 687.8 ± SD 136.3 in 10-6mm2/s). The tumors originated never infratentorial and were never centered in the midline. Metastases were rare. CONCLUSIONS: For the first time, imaging characteristics of the recently described CNS NB-FOXR2 are described in a multi-center cohort. The results of this study may assist in diagnosing these tumors preoperatively. Collaborative pooling of cases is important to gain insight into typical imaging features of rare tumors, especially in view of the increasing molecular-driven subtyping.
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Affiliation(s)
- Anna Tietze
- Charité Universituatsmedizin Berlin , Berlin, Berlin , Germany
| | - Maarten H Lequin
- University Medical Center Utrecht , Utrecht, Utrecht , Netherlands
| | - Brigitte Bison
- University Hospital Augsburg , Augsburg, Augsburg , Germany
| | - Liz Ivarsson
- Queen Silvias Children′s Hospital, Sahlgrenska University Hospital , Gotheburg, Gothenburg , Sweden
| | - David Mirsky
- Children’s Hospital Colorado , Denver, Denver , USA
| | - Alok Jaju
- Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Chicago , USA
| | - Ulrike Löbel
- Great Ormond Street Hospital, London , London , United Kingdom
| | - Katja von Hoff
- Charité Universituatsmedizin Berlin , Berlin, Berlin , Germany
| | - Kshitij Mankad
- Great Ormond Street Hospital, London , London , United Kingdom
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Chopra T, Neuberger I, Prince E, White C, Maloney J, Stence N, Mirsky D. Age-related changes in the completeness of the circle of Willis in children. Childs Nerv Syst 2022; 38:1181-1184. [PMID: 35394211 DOI: 10.1007/s00381-022-05505-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The circle of Willis is a circulatory anastomosis that supplies blood to the brain. If any of the bridging segments are hypoplastic or absent, the capacity for collateral flow in the setting of large vessel occlusion may be decreased. Outside of the neonatal period, the prevalence of a complete circle of Willis (CoW) in the pediatric population has not been well described. Our objectives include determining the prevalence of a complete CoW in children and identifying if there is an age-related "loss" of arterial segments. METHODS Following IRB approval, angiograms of the CoW performed on a 3-T MR platform from 2016 to 2020 on patients 21 years or younger were retrospectively reviewed. Any patient with underlying arterial pathology that may affect the CoW was excluded. Patient age and gender at the time of imaging were obtained. RESULTS In total, 592 pediatric CoW were assessed. Frequencies of completeness were calculated in two different fashions: scenario 1 where a CoW was characterized as complete even if it contained hypoplastic vessels (88.8%), and scenario 2 where it was characterized as complete after excluding hypoplastic vessels (44.0%). In both scenarios, our data showed that older age was more associated with an incomplete CoW (p < 0.0001). In addition, we found a higher percentage of males with an incomplete CoW compared with females (p < 0.0001). CONCLUSIONS The presence of a complete CoW is greater in our pediatric population than what has been reported in adults. The prevalence of an incomplete circle of Willis also increases significantly with age.
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Affiliation(s)
- Tavishi Chopra
- Creighton University School of Medicine, AZ, Phoenix, USA.
| | | | - Eric Prince
- University of Colorado Anschutz Medical Campus, Aurora, USA
| | | | - John Maloney
- Neuroradiology, Children's Hospital Colorado, Aurora, USA
| | | | - David Mirsky
- Neuroradiology, Children's Hospital Colorado, Aurora, USA
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Demarest S, Calhoun J, Eschbach K, Yu HC, Mirsky D, Angione K, Shaikh TH, Carvill GL, Benke TA, Gunti J, Vanderveen G. Whole-exome sequencing and adrenocorticotropic hormone therapy in individuals with infantile spasms. Dev Med Child Neurol 2022; 64:633-640. [PMID: 35830182 DOI: 10.1111/dmcn.15109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022]
Abstract
AIM To identify additional genes associated with infantile spasms using a cohort with defined infantile spasms. METHOD Whole-exome sequencing (WES) was performed on 21 consented individuals with infantile spasms and their unaffected parents (a trio-based study). Clinical history and imaging were reviewed. Potentially deleterious exonic variants were identified and segregated. To refine potential candidates, variants were further prioritized on the basis of evidence for relevance to disease phenotype or known associations with infantile spasms, epilepsy, or neurological disease. RESULTS Likely pathogenic de novo variants were identified in NR2F1, GNB1, NEUROD2, GABRA2, and NDUFAF5. Suggestive dominant and recessive candidate variants were identified in PEMT, DYNC1I1, ASXL1, RALGAPB, and STRADA; further confirmation is required to support their relevance to disease etiology. INTERPRETATION This study supports the utility of WES in uncovering the genetic etiology in undiagnosed individuals with infantile spasms with an overall yield of five out of 21. High-priority candidates were identified in an additional five individuals. WES provides additional support for previously described disease-associated genes and expands their already broad mutational and phenotypic spectrum.
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Affiliation(s)
- Scott Demarest
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Jeff Calhoun
- Ken and Ruth Davee Department of Neurology, Northwestern University, School of Medicine, Chicago, IL, USA
| | - Krista Eschbach
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Hung-Chun Yu
- Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - David Mirsky
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Radiology, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Katie Angione
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Tamim H Shaikh
- Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Gemma L Carvill
- Ken and Ruth Davee Department of Neurology, Northwestern University, School of Medicine, Chicago, IL, USA.,Department of Pharmacology, Northwestern University, School of Medicine, Chicago, IL, USA.,Department of Pediatrics, Northwestern University, School of Medicine, Chicago, IL, USA
| | - Tim A Benke
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA.,Department of Pharmacology, University of Colorado, School of Medicine, Aurora, CO, USA.,Department of Neurology, University of Colorado, School of Medicine, Aurora, CO, USA.,Department of Otolaryngology, University of Colorado, School of Medicine, Aurora, CO, USA
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12
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Mirsky D, Prince E, Staulcup S, Hengartner A, Vijmasi T, Johnston J, Massimi L, Anderson R, Souweidane M, Naftel R, Limbrick D, Grant G, Niazi T, Dudley R, Kilburn L, Jackson E, Jallo G, Ginn K, Smith A, Chern J, Lee A, Drapeau A, Krieger M, Handler M, Hankinson T. RARE-11. QUANTITATIVE MR IMAGING FEATURES ASSOCIATED WITH UNIQUE TRANSCRIPTIONAL CHARACTERISTICS IN PEDIATRIC ADAMANTINOMATOUS CRANIOPHARYNGIOMA: A POTENTIAL GUIDE FOR THERAPY. Neuro Oncol 2020. [PMCID: PMC7715942 DOI: 10.1093/neuonc/noaa222.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
METHODS Through the Advancing Treatment for Pediatric Craniopharyngioma (ATPC) consortium we accumulated preoperative MRIs and tumor RNA for 50 unique ACP patients. MRIs were assessed quantitatively for 28 different features and analyzed using Multiple Factor Analysis (MFA) and optimal clustering was determined via maximization of Bayesian Information Criterion (BIC). Following bulk RNAseq, differential expression and pathway enrichment were performed using standard methodologies (i.e., DESeq2 and GSEA). RESULTS MRI features were well represented in the first 3 dimensions of MFA (variance explained=67.32%); specifically tumor/cyst size, ventricular size, and cyst fluid diffusivity. Using this three-way axis, we identified 3 patient subgroups. Transcriptional differences between these subgroups indicated one group was enriched for DNA damage response and MYC related pathways, one group enriched for SHH, and one group enriched for WNT/β-catenin and EMT-related pathways. CONCLUSION This preliminary work suggests that there may be unique gene expression variants within ACP, which may be identified preoperatively using easily quantifiable MRI parameters. These radiogenomic signatures could provide prognostic information and/or guidance in the selection of antitumor therapies for children with ACP.
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Affiliation(s)
| | - Eric Prince
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | | | | | - James Johnston
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luca Massimi
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mark Souweidane
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Robert Naftel
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Limbrick
- Washington University School of Medicine, St. Louis, MO, USA
| | - Gerald Grant
- Lucile Packard Children’s Hospital at Stanford University, Palo Alto, CA, USA
| | - Toba Niazi
- Nicklaus Children’s Hospital, Miami, FL, USA
| | | | | | - Eric Jackson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Jallo
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Kevin Ginn
- Children’s Mercy Hospital, Kansas City, MO, USA
| | - Amy Smith
- Arnold Palmer Hospital, Orlando, FL, USA
| | - Joshua Chern
- Emory University School of Medicine, Atlanta, GA, USA
| | - Amy Lee
- Seattle Children’s Hospital, Seattle, WA, USA
| | | | - Mark Krieger
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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13
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Chhabda S, Malik P, Reddy N, Muthusamy K, Mirsky D, Sudhakar S, Mankad K. Relapsing Demyelinating Syndromes in Children: A Practical Review of Neuroradiological Mimics. Front Neurol 2020; 11:627. [PMID: 32849169 PMCID: PMC7417677 DOI: 10.3389/fneur.2020.00627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/28/2020] [Indexed: 01/02/2023] Open
Abstract
Relapsing demyelinating syndromes (RDS) in children encompass a diverse spectrum of entities including multiple sclerosis (MS) acute disseminated encephalomyelitis (ADEM), aquaporin-4 antibody associated neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOG-AD). In addition to these, there are “antibody-negative” demyelinating syndromes which are yet to be fully characterized and defined. The paucity of specific biomarkers and overlap in clinical presentations makes the distinction between these disease entities difficult at initial presentation and, as such, there is a heavy reliance on magnetic resonance imaging (MRI) findings to satisfy the criteria for treatment initiation and optimization. Misdiagnosis is not uncommon and is usually related to the inaccurate application of criteria or failure to identify potential clinical and radiological mimics. It is also notable that there are instances where AQP4 and MOG antibody testing may be falsely negative during initial clinical episodes, further complicating the issue. This article illustrates the typical clinico-radiological phenotypes associated with the known pediatric RDS at presentation and describes the neuroimaging mimics of these using a pattern-based approach in the brain, optic nerves, and spinal cord. Practical guidance on key distinguishing features in the form of clinical and radiological red flags are incorporated. A subsection on clinical mimics with characteristic imaging patterns that assist in establishing alternative diagnoses is also included.
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Affiliation(s)
- Sahil Chhabda
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Prateek Malik
- Christian Medical College & Hospital, Vellore, India
| | | | | | - David Mirsky
- Children's Hospital Colorado, Aurora, CO, United States
| | - Sniya Sudhakar
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom.,Associate Honorary Professor, Institute of Child Health, University College London, London, United Kingdom
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14
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Sidpra J, Gaier C, Reddy N, Kumar N, Mirsky D, Mankad K. Sustaining education in the age of COVID-19: a survey of synchronous web-based platforms. Quant Imaging Med Surg 2020; 10:1422-1427. [PMID: 32676361 DOI: 10.21037/qims-20-714] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jai Sidpra
- University College London Medical School, London, UK
| | - Celia Gaier
- University College London Medical School, London, UK
| | - Nihaal Reddy
- Department of Radiology, Rainbow Children's Hospital and Tenet Diagnostics, Hyderabad, India
| | - Neetu Kumar
- Department of Urology, Great Ormond Street Hospital, London, UK
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, UK
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15
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Baltensperger A, Mirsky D, Maloney J, Neuberger I, Fenton L, Bernard T, Borgstede J, Stence N. Cost and Utility of Routine Contrast-Enhanced Neck MRA in a Pediatric MRI Stroke Evaluation Protocol. AJNR Am J Neuroradiol 2019; 40:2143-2145. [PMID: 31727745 DOI: 10.3174/ajnr.a6315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Cervical arterial dissection is one of the frequent causes of pediatric arterial ischemic stroke. Out of concern for missing cervical arterial dissection in patients in whom pediatric stroke is suspected, our tertiary children's hospital added contrast-enhanced 3D neck MR angiography to every pediatric stoke work-up. This research investigated whether the routine use of contrast-enhanced neck MRA in our MR imaging stroke protocol ever detected a cervical arterial abnormality when the DWI, SWI/gradient recalled-echo, or circle of Willis MRA findings from the brain MR imaging were reported as normal. MATERIALS AND METHODS The institutional PACS data base was searched for stroke protocol MRIs that included DWI, gradient recalled-echo or SWI, circle of Willis MRA, and 3D contrast-enhanced neck MRA in patients younger than 18 years of age with examinations performed between September 2010 and June 2017. RESULTS In only a single case (0.15%) were the DWI, SWI/gradient recalled-echo, or circle of Willis MRA findings all separately reported as normal and the contrast-enhanced neck MRA findings reported as abnormal. To reach these findings, we screened 681 patients, which would have resulted in an estimated >$200,000 in Medicare charges and $80,000 in of out-of-pocket cost to patients. CONCLUSIONS In our large series, the addition of a routine contrast-enhanced neck MRA to our pediatric stroke MR imaging protocol was of extremely low yield. We believe the use of neck MRA should reasonably be limited to cases in which abnormalities are initially detected on standard brain sequences or to patients with atypical presentation or recurrent pathology.
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Affiliation(s)
| | - D Mirsky
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
| | - J Maloney
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
| | - I Neuberger
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
| | - L Fenton
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
| | - T Bernard
- From the Department of Pediatrics (A.B., T.B.)
| | - J Borgstede
- Section of Pediatric Radiology, and Department of Radiology (J.B.), University of Colorado School of Medicine, Aurora, Colorado
| | - N Stence
- Section of Child Neurology, Department of Radiology (D.M., J.M., I.N., L.F., N.S.)
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16
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Norris GA, Garcia J, Hankinson TC, Handler M, Foreman N, Mirsky D, Stence N, Dorris K, Green AL. Diagnostic accuracy of neuroimaging in pediatric optic chiasm/sellar/suprasellar tumors. Pediatr Blood Cancer 2019; 66:e27680. [PMID: 30848081 DOI: 10.1002/pbc.27680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 01/07/2023]
Abstract
Preoperative diagnosis for tumors arising in the optic chiasm/sellar/suprasellar region in children is helpful to determine surgical necessity and approach, given the high operative risk in this area. We evaluated the ability to differentiate tumor type by preoperative neuroimaging. Thirty-eight of 53 tumors were correctly diagnosed by neuroimaging based on final pathologic diagnosis (prediction accuracy 72%). Prediction accuracies were 87% (20/23) for craniopharyngioma, 79% (11/14) for optic pathway glioma, 64% (7/11) for germ cell tumor, and 0% (0/5) for Langerhans cell histiocytosis. Diagnosis of optic chiasm/sellar/suprasellar tumors in children by imaging alone should be considered when biopsy is considered high risk.
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Affiliation(s)
- Gregory A Norris
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jacquelyn Garcia
- Division of Pediatric Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Todd C Hankinson
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.,Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado
| | - Michael Handler
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.,Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado
| | - Nicholas Foreman
- Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado.,Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - David Mirsky
- Division of Pediatric Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Nicholas Stence
- Division of Pediatric Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Kathleen Dorris
- Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado.,Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Adam L Green
- Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado.,Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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17
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Prince E, Whelan R, Vijmasi T, Staulcup S, Klimo P, Mirsky D, Stence N, Hankinson T. THER-19. MACHINE LEARNING APPROACH TO TUMOR DIAGNOSIS USING SMALL DATASETS: PROOF OF PRINCIPLE USING PEDIATRIC ADAMANTINOMATOUS CRANIOPHARYNGIOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric Prince
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Ros Whelan
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | | | - Paul Klimo
- St. Jude Children’s Research Hospital, Memphis, TN, USA
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18
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Grob S, Donson A, Prince E, Vijmasi T, Foreman N, Dahl N, Vibhakar R, Mirsky D, Hankinson T, Levy JM. THER-33. TOCILIZUMAB AS A POTENTIAL NOVEL THERAPY IN PATIENTS DIAGNOSED WITH ADAMANTINOMATOUS CRANIOPHARYNGIOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sydney Grob
- University of Colorado and Children’s Hospital Colorado, Department of Pediatrics, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Andrew Donson
- University of Colorado and Children’s Hospital Colorado, Department of Pediatrics, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Eric Prince
- University of Colorado and Children’s Hospital Colorado, Department of Neurosurgery, Aurora, CO, USA
| | - Trinka Vijmasi
- University of Colorado and Children’s Hospital Colorado, Department of Neurosurgery, Aurora, CO, USA
| | - Nicholas Foreman
- University of Colorado and Children’s Hospital Colorado, Department of Pediatrics, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Nathan Dahl
- University of Colorado and Children’s Hospital Colorado, Department of Pediatrics, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Rajeev Vibhakar
- University of Colorado and Children’s Hospital Colorado, Department of Pediatrics, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - David Mirsky
- University of Colorado and Children’s Hospital Colorado, Department of Radiology, Aurora, CO, USA
| | - Todd Hankinson
- University of Colorado and Children’s Hospital Colorado, Department of Neurosurgery, Aurora, CO, USA
| | - Jean Mulcahy Levy
- University of Colorado and Children’s Hospital Colorado, Department of Pediatrics, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
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19
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Reddy K, Mirsky D, Kenny A, Thornhill D, Bernard T, Stence N. Abstract WMP116: Acute Infarct Volume in Childhood Stroke Can Be Accurately Estimated by Modelling Contraction of Chronic Infarction. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wmp116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Arterial ischemic stroke (AIS) occurs in 1-2 children/100,000/year. Most children have neurologic deficits post-AIS, but the influence of infarct volume on neurologic outcome is understudied. While acute infarct volume {best measured as a percentage of total brain volume infarcted (%aTBVi) in the growing brain} likely predicts outcome, acute scans are not always available in children. Chronic infarct volumes are underestimated by direct measurement due to contraction. A method for estimating acute infarct volumes from chronic scans is needed. We developed and compared the reliability of three methods for estimating the %aTBVi from values measured on chronic images.
Methods:
A retrospective IRB-approved study studying children (age 1 month-17 years) with AIS enrolled 158 patients. Those with acute (<3 days) and chronic (>90 days) MRIs were manually segmented by a pediatric neuroradiologist. Method 1 (direct method, used as control) estimated %aTBVi by measuring chronic infarct volume (cVI) and dividing by total brain volume. Method 2 (OFC method) estimated %aTBVi by subtracting the total non-infarcted brain volume from an extrapolated total brain volume based on orbitofrontal circumference (OFC). Method 3 (contraction method, Figure 1) used a regression model to apply a correction factor to the direct measurement of cVI that was then divided by total brain volume to estimate %aTBVi. Intraclass correlation compared estimated %aTBVi of the three methods to the gold standard %aTBVi calculated from manual segmentation of acute scans.
Results:
Inclusion criteria were met by 86 patients. The control direct method had excellent reliability (ICC 0.79), although it was exceeded by the contraction method (Figure 1, ICC=0.86), while the OFC method reliability was poor (ICC=0.42).
Conclusion:
%aTBVi is reliably estimated in children with AIS with only chronic imaging via the contraction method.
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Affiliation(s)
- Kartik Reddy
- Radiology, Univ of Colorado Anschutz Sch of Medicine, Aurora, CO
| | - David Mirsky
- Radiology, Univ of Colorado Anschutz Sch of Medicine, Aurora, CO
| | - Amanda Kenny
- Hemophilia and Thrombosis Cntr, Univ of Colorado Anschutz Sch of Medicine, Aurora, CO
| | - Dianne Thornhill
- Hemophilia and Thrombosis Cntr, Univ of Colorado Anschutz Sch of Medicine, Aurora, CO
| | - Timothy Bernard
- Pediatrics, Univ of Colorado Anschutz Sch of Medicine, Aurora, CO
| | - Nicholas Stence
- Radiology, Univ of Colorado Anschutz Sch of Medicine, Aurora, CO
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Abstract
PURPOSE Sacral abnormalities range from missing the coccyx, a few sacral vertebrae, or hemi-sacrum, to complete absence with fused iliac bones. The purpose of this study was to review the association between sacral agenesis and fecal incontinence to help inform patient prognosis. METHODS A retrospective review was performed of patients who presented for bowel management due to sacral agenesis at a tertiary care children's hospital between 2016 and 2017 (n = 10). Data collection included: gender, time of diagnosis, sacral ratio, and associated anomalies. Patients with anorectal malformation and sacrococcygeal teratomas were excluded. RESULTS Four patients were female. Seven patients had a delayed diagnosis ranging from 22 months of age to 9 years. Most common symptoms included failure of age-appropriate toilet training and severe diaper rash. The sacral ratio was zero (6), 0.3 and 0.4 (2), and hemi-sacrum (2). Associated anomalies were present in five patients. CONCLUSION Sacral abnormalities should be suspected in patients who present with early severe diaper rash and those who fail to toilet train. An abdominal radiograph can evaluate the sacrum, when the sacral ratio is 0.4 or less, parents should be counseled regarding fecal incontinence and neurogenic bladder.
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Affiliation(s)
| | - Alberto Peña
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, Aurora, USA
| | - Jill Ketzer
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA
| | - Andrea Bischoff
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA.
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21
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Bischoff A, Peña A, Ketzer J, Campbell K, O' Neill B, Stence N, Mirsky D. The conus medullaris ratio: A new way to identify tethered cord on MRI. J Pediatr Surg 2019; 54:280-284. [PMID: 30518494 DOI: 10.1016/j.jpedsurg.2018.10.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Approximately 25% of patients with anorectal malformation have tethered cord. The traditional way of determining conus medullaris level on magnetic resonance imaging (MRI) relies on counting vertebrae, which may be challenging due to vertebral numeric variation, segmentation anomalies, as well as transitional vertebral body anatomy. The purpose of this study was to utilize more reliable anatomic landmarks (foramen magnum, conus termination, and the upper limit of the iliac crest) to establish a consistent ratio that may differentiate patients with normal and low-lying conus. METHODS A single institution database search identified two groups of patients: 255 with normal and 85 with abnormal spinal MRI, who underwent tethered cord release. The conus medullaris ratio was calculated in both groups. The ratio was obtained by dividing the distance between the conus level and the iliac crest by the distance between the foramen magnum and the conus level (IRB # 16-2330). RESULTS The mean ratio was significantly higher in the non-tethered group compared to the tethered patients (0.184 [sd 0.03] versus 0.118 [sd 0.09]; P < .0001). The ratio proved to be a good discriminator between normal and abnormal patients, with area under the curve (AUC) equal to 0.749, meaning that at random, there is a 75% chance that the tethered cord patient will have a lower ratio than the non-tethered cord patient. CONCLUSION "The Conus Medullaris Ratio" is a good predictor of low-lying conus level on MRI and offers an easy alternative to counting vertebral body levels, particularly in patients with variant or abnormal vertebral body anatomy. LEVEL OF EVIDENCE II, Study of Diagnostic Test.
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Affiliation(s)
- Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Department of Pediatric Surgery.
| | - Alberto Peña
- International Center for Colorectal and Urogenital Care, Department of Pediatric Surgery
| | - Jill Ketzer
- International Center for Colorectal and Urogenital Care, Department of Pediatric Surgery
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22
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Saporta-Keating SR, Simões EAF, Yu G, Federman S, Mirsky D, Dominguez SR, Chiu CY, Messacar K. A Child With Intermittent Headaches and Eosinophilic Meningitis. J Pediatric Infect Dis Soc 2018; 7:355-357. [PMID: 29438532 PMCID: PMC6276032 DOI: 10.1093/jpids/piy005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sara R Saporta-Keating
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Eric A F Simões
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | - Guixia Yu
- Department of Laboratory Medicine, University of California San Francisco
- University of California San Francisco–Abbott Viral Diagnostics and Discovery Center
| | - Scot Federman
- Department of Laboratory Medicine, University of California San Francisco
- University of California San Francisco–Abbott Viral Diagnostics and Discovery Center
| | - David Mirsky
- Department of Radiology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Samuel R Dominguez
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California San Francisco
- University of California San Francisco–Abbott Viral Diagnostics and Discovery Center
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco
| | - Kevin Messacar
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
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23
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Boehnke M, Mirsky D, Stence N, Stanley RM, Lindberg DM. Occult head injury is common in children with concern for physical abuse. Pediatr Radiol 2018; 48:1123-1129. [PMID: 29654352 DOI: 10.1007/s00247-018-4128-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/08/2018] [Accepted: 03/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies evaluating small patient cohorts have found a high, but variable, rate of occult head injury in children <2 years old with concern for physical abuse. The American College of Radiology (ACR) recommends clinicians have a low threshold to obtain neuroimaging in these patients. OBJECTIVES Our aim was to determine the prevalence of occult head injury in a large patient cohort with suspected physical abuse using similar selection criteria from previous studies. Additionally, we evaluated proposed risk factors for associations with occult head injury. MATERIALS AND METHODS This was a retrospective, secondary analysis of data collected by an observational study of 20 U.S. child abuse teams that evaluated children who underwent subspecialty evaluation for concern of abuse. We evaluated children <2 years old and excluded those with abnormal mental status, bulging fontanelle, seizure, respiratory arrest, underlying neurological condition, focal neurological deficit or scalp injury. RESULTS One thousand one hundred forty-three subjects met inclusion criteria and 62.5% (714) underwent neuroimaging with either head computed tomography or magnetic resonance imaging. We found an occult head injury prevalence of 19.7% (141). Subjects with emesis (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-6.8), macrocephaly (OR 8.5, 95% CI 3.7-20.2), and loss of consciousness (OR 5.1, 95% CI 1.2-22.9) had higher odds of occult head injury. CONCLUSION Our results show a high prevalence of occult head injury in patients <2 years old with suspected physical abuse. Our data support the ACR recommendation that clinicians should have a low threshold to perform neuroimaging in patients <2 years of age.
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Affiliation(s)
- Mitchell Boehnke
- Department of Diagnostic Radiology, Children's Hospital Colorado, 12631 East 17th Ave., Mail Stop 8200, Aurora, CO, 80045, USA. .,University of Colorado School of Medicine, Aurora, CO, USA.
| | - David Mirsky
- Department of Diagnostic Radiology, Children's Hospital Colorado, 12631 East 17th Ave., Mail Stop 8200, Aurora, CO, 80045, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicholas Stence
- Department of Diagnostic Radiology, Children's Hospital Colorado, 12631 East 17th Ave., Mail Stop 8200, Aurora, CO, 80045, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel M Stanley
- Department of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University School of Medicine, Columbus, OH, USA
| | - Daniel M Lindberg
- University of Colorado School of Medicine, Aurora, CO, USA.,The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, Aurora, CO, USA
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24
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Whelan R, Prince E, Mirsky D, Naftel R, Bhatia A, Pettorini B, Avula S, Staulcup S, Cox-Martin M, Hankinson T. NSRG-13. INTER-RATER RELIABILITY OF A METHOD FOR DETERMINING THE PRE-OPERATIVE HYPOTHALAMIC INVOLVEMENT OF PEDIATRIC CRANIOPHARYNGIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ros Whelan
- University of Colorado Hospital, Aurora, CO, USA
| | - Eric Prince
- University of Colorado Hospital, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | - Robert Naftel
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aashim Bhatia
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Matthew Cox-Martin
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) University of Colorado School of Medicine, Aurora, CO, USA
| | - Todd Hankinson
- University of Colorado Hospital, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
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25
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Stence N, Mulcahy-Levy J, Hoffman L, Green A, Mirsky D, Neuberger I, Fenton L, Maloney J, Kleinschmidt-DeMasters B, Vibhakar R, Foreman N, Dorris K. RADI-21. IMAGING CHARACTERISTICS OF BRAF V600E MUTATED PEDIATRIC BRAIN TUMORS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicholas Stence
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Jean Mulcahy-Levy
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Lindsey Hoffman
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Adam Green
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - David Mirsky
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Ilana Neuberger
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Laura Fenton
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - John Maloney
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | - Rajeev Vibhakar
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Nicholas Foreman
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Kathleen Dorris
- University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
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26
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Norris G, Garcia J, Hankinson T, Handler M, Foreman N, Mirsky D, Stence N, Dorris K, Green A. RADI-22. DIAGNOSTIC ACCURACY OF NEUROIMAGING IN PEDIATRIC OPTIC PATHWAY/SELLAR/SUPRASELLAR TUMORS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Adam Green
- Children’s Hospital Colorado, Denver, CO, USA
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27
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Bhatt P, Dorris K, Levy JM, Schneider KW, Suttman A, Donson A, Foreman N, Kleinschmidt-DeMasters BK, Spence N, Neuberger I, Mirsky D. RADI-14. SPORADIC MENINGIOMAS OF THE PEDIATRIC POPULATION: A REVIEW OF NEURORADIOLOGICAL, NEUROPATHOLOGICAL, AND NEURO-ONCOLOGICAL ATTRIBUTES. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paraag Bhatt
- University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA
| | - Kathleen Dorris
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Denver, CO, USA
| | - Jean Mulcahy Levy
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Denver, CO, USA
| | | | | | - Andrew Donson
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Denver, CO, USA
| | - Nicholas Foreman
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Denver, CO, USA
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Abstract
A rare autosomal recessive disorder caused by mutations in the B3GALT6 gene on chromosome 1p36 results in deficiency of β-1,3-galactosyltransferase 6, an enzyme critical for glycosaminoglycan biosynthesis. Defects in this gene result in a phenotype that has features of both skeletal dysplasia and a connective tissue disorder. The anesthetic considerations for children with this disorder have not previously been described. We report a collaborative, multidisciplinary approach to the perioperative care of a child with B3GALT6 mutations with severe phenotypic expression.
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Affiliation(s)
- Megan Brockel
- From the Department of Anesthesiology, Section of Pediatric Anesthesiology, Department of Pediatrics, Section of Cardiology, Department of Radiology, and Department of Pediatrics, Section of Pulmonary Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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29
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Karaa A, Rahman S, Lombès A, Yu-Wai-Man P, Sheikh MK, Alai-Hansen S, Cohen BH, Dimmock D, Emrick L, Falk MJ, McCormack S, Mirsky D, Moore T, Parikh S, Shoffner J, Taivassalo T, Tarnopolsky M, Tein I, Odenkirchen JC, Goldstein A. Erratum to: Common data elements for clinical research in mitochondrial disease: a National Institute for Neurological Disorders and Stroke project. J Inherit Metab Dis 2018; 41:151. [PMID: 28980269 PMCID: PMC7790127 DOI: 10.1007/s10545-017-0081-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Amel Karaa
- Massachusetts General Hospital, Boston, MA, USA
| | - Shamima Rahman
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Anne Lombès
- INSERM, Institut Cochin U1016, Paris, France
| | - Patrick Yu-Wai-Man
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
| | | | | | | | | | - Lisa Emrick
- Baylor College of Medicine, Houston, TX, USA
| | - Marni J Falk
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shana McCormack
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Tony Moore
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital, London, UK
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Ingrid Tein
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joanne C Odenkirchen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Amy Goldstein
- Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
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30
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Schur S, Allen V, White A, Mirsky D, Stence N, O'Neill B, Handler M, Dudley R, Laoprasert P. Significance of FDG-PET Hypermetabolism in Children with Intractable Focal Epilepsy. Pediatr Neurosurg 2018; 53:153-162. [PMID: 29672310 DOI: 10.1159/000487088] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/21/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interictal 18F-fluorodeoxyglucose-positron emission topography (FDG-PET) hypometabolism is routinely used in the presurgical workup of children with medically intractable epilepsy (MIE). FDG-PET hypermetabolism, however, is rarely seen, and the significance of this finding in the epilepsy workup is not well established. METHODS We performed a retrospective study of patients who underwent FDG-PET during the presurgical workup of MIE over a 4-year period, between 1 January 2010 and 31 December 2013, at the Children's Hospital Colorado, CO, USA. RESULTS Focal FDG-PET hypermetabolism was identified in 7 (2.2%) of 317 patients. The median age was 124 months, all cases with catastrophic epilepsy. Surface electroencephalography (EEG) performed concomitantly with FDG injections revealed ictal EEG discharges in 2 patients, frequent interictal epileptiform discharges (IEDs) in 3, occasional IEDs in 1, and no IEDs in 1. All 7 patients underwent functional hemispherectomies. Histopathology revealed type 1 focal cortical dysplasia in all patients. Six (86%) were completely seizure-free (Engel class I) and 1 had extremely infrequent seizures (Engel class II) (mean follow-up, 47.4 months). CONCLUSION While a rare finding, interictal PET hypermetabolism does occur, may help identify epileptogenic zones, and assessment to reveal it should be made by concomitant use of surface EEG during PET scans.
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Affiliation(s)
- Solon Schur
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University Health Center, Montreal, Québec, Canada
| | - Victoria Allen
- Department of Neurology, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, USA
| | - Andrew White
- Department of Neurology, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, USA
| | - David Mirsky
- Department of Neuroradiology, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, USA
| | - Nicholas Stence
- Department of Neuroradiology, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, USA
| | - Brent O'Neill
- Department of Neurosurgery, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, USA
| | - Michael Handler
- Department of Neurosurgery, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, USA
| | - Roy Dudley
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Québec, Canada
| | - Pramote Laoprasert
- Department of Neurology, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, USA
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31
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Karaa A, Rahman S, Lombès A, Yu-Wai-Man P, Sheikh MK, Alai-Hansen S, Cohen BH, Dimmock D, Emrick L, Falk MJ, McCormack S, Mirsky D, Moore T, Parikh S, Shoffner J, Taivassalo T, Tarnopolsky M, Tein I, Odenkirchen JC, Goldstein A. Common data elements for clinical research in mitochondrial disease: a National Institute for Neurological Disorders and Stroke project. J Inherit Metab Dis 2017; 40:403-414. [PMID: 28303425 PMCID: PMC7783474 DOI: 10.1007/s10545-017-0035-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/15/2017] [Accepted: 03/01/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The common data elements (CDE) project was developed by the National Institute of Neurological Disorders and Stroke (NINDS) to provide clinical researchers with tools to improve data quality and allow for harmonization of data collected in different research studies. CDEs have been created for several neurological diseases; the aim of this project was to develop CDEs specifically curated for mitochondrial disease (Mito) to enhance clinical research. METHODS Nine working groups (WGs), composed of international mitochondrial disease experts, provided recommendations for Mito clinical research. They initially reviewed existing NINDS CDEs and instruments, and developed new data elements or instruments when needed. Recommendations were organized, internally reviewed by the Mito WGs, and posted online for external public comment for a period of eight weeks. The final version was again reviewed by all WGs and the NINDS CDE team prior to posting for public use. RESULTS The NINDS Mito CDEs and supporting documents are publicly available on the NINDS CDE website ( https://commondataelements.ninds.nih.gov/ ), organized into domain categories such as Participant/Subject Characteristics, Assessments, and Examinations. CONCLUSION We developed a comprehensive set of CDE recommendations, data definitions, case report forms (CRFs), and guidelines for use in Mito clinical research. The widespread use of CDEs is intended to enhance Mito clinical research endeavors, including natural history studies, clinical trial design, and data sharing. Ongoing international collaboration will facilitate regular review, updates and online publication of Mito CDEs, and support improved consistency of data collection and reporting.
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Affiliation(s)
- Amel Karaa
- Massachusetts General Hospital, Boston, MA, USA
| | - Shamima Rahman
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Anne Lombès
- INSERM, Institut Cochin U1016, Paris, France
| | - Patrick Yu-Wai-Man
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
| | | | | | | | | | - Lisa Emrick
- Baylor College of Medicine, Houston, TX, USA
| | - Marni J Falk
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shana McCormack
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Tony Moore
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital, London, UK
- Department of Ophthalmology, University of California, San Francisco, USA
| | | | | | | | | | - Ingrid Tein
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joanne C Odenkirchen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Amy Goldstein
- Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
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32
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Nagae LM, Lall N, Dahmoush H, Nyberg E, Mirsky D, Drees C, Honce JM. Diagnostic, treatment, and surgical imaging in epilepsy. Clin Imaging 2016; 40:624-36. [DOI: 10.1016/j.clinimag.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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33
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Levy JM, Zahedi S, Griesinger A, Davies K, Eisner D, Kleinschmidt-DeMasters B, Fitzwalter B, Goodall M, Amani V, Donson A, Birks D, Mirsky D, Hankinson T, Handler M, Foreman N, Foreman A. TB-19AUTOPHAGY INHIBITION OVERCOMES RESISTANCE TO BRAF INHIBITION IN BRAIN TUMORS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now084.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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34
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Mirsky D, Feygin T. Imaging of Fetal Orbits. J Pediatr Neuroradiol 2016. [DOI: 10.1055/s-0036-1584225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- David Mirsky
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Tamara Feygin
- Department of Radiology, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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35
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Greninger AL, Messacar K, Dunnebacke T, Naccache SN, Federman S, Bouquet J, Mirsky D, Nomura Y, Yagi S, Glaser C, Vollmer M, Press CA, Kleinschmidt-DeMasters BK, Dominguez SR, Chiu CY. Erratum to: Clinical metagenomic identification of Balamuthia mandrillaris encephalitis and assembly of the draft genome: the continuing case for reference genome sequencing. Genome Med 2016; 8:1. [PMID: 26750923 PMCID: PMC4707724 DOI: 10.1186/s13073-015-0257-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Alexander L Greninger
- Department of Laboratory Medicine, University of California, 185 Berry Street, San Francisco, 94107, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, 91407, CA, USA
| | - Kevin Messacar
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Samia N Naccache
- Department of Laboratory Medicine, University of California, 185 Berry Street, San Francisco, 94107, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, 91407, CA, USA
| | - Scot Federman
- Department of Laboratory Medicine, University of California, 185 Berry Street, San Francisco, 94107, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, 91407, CA, USA
| | - Jerome Bouquet
- Department of Laboratory Medicine, University of California, 185 Berry Street, San Francisco, 94107, CA, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, 91407, CA, USA
| | - David Mirsky
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Yosuke Nomura
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Shigeo Yagi
- California Department of Public Health, Richmond, CA, USA
| | | | | | - Craig A Press
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Samuel R Dominguez
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, 185 Berry Street, San Francisco, 94107, CA, USA. .,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, 91407, CA, USA. .,Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, 94107, CA, USA.
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36
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Ehrig J, Meyers M, Behrendt N, Howley L, Cuneo B, Mirsky D, Zaretsky M, Liechty K, Crombleholme T, Galan HL. 608: Abnormal fetal vascular studies in Twin Twin Transfusion Syndrome (TTTS) and their association to abnormalities in fetal brain MRI. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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37
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Nomura Y, Greninger A, Messacar K, Dunnebacke T, Naccache SN, Bouquet J, Mirsky D, Press C, Kleinschmidt-Demasters BK, Parker S, Dominguez S, Chiu CY. Balamuthia Mandrillaris Encephalitis Detected by Next Generation Sequencing of Cerebrospinal Fluid. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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38
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Olson D, Moen A, Barr E, Mirsky D, Schreiner T, Abzug MJ. An 8-Year-Old Boy With Ascending Paralysis. J Pediatric Infect Dis Soc 2015; 4:385-8. [PMID: 26407267 DOI: 10.1093/jpids/piv034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 05/02/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel Olson
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Amanda Moen
- Department of Pediatrics, Section of Neurology, Gillette Children's Specialty Healthcare, St. Paul, Minnesota
| | - Emily Barr
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | | | - Teri Schreiner
- Department of Pediatrics, Section of Neurology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Mark J Abzug
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
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39
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Greninger AL, Messacar K, Dunnebacke T, Naccache SN, Federman S, Bouquet J, Mirsky D, Nomura Y, Yagi S, Glaser C, Vollmer M, Press CA, Kleinschmidt-DeMasters BK, Klenschmidt-DeMasters BK, Dominguez SR, Chiu CY. Clinical metagenomic identification of Balamuthia mandrillaris encephalitis and assembly of the draft genome: the continuing case for reference genome sequencing. Genome Med 2015; 7:113. [PMID: 26620704 PMCID: PMC4665321 DOI: 10.1186/s13073-015-0235-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/13/2015] [Indexed: 01/10/2023] Open
Abstract
Background Primary amoebic meningoencephalitis (PAM) is a rare, often lethal, cause of encephalitis, for which early diagnosis and prompt initiation of combination antimicrobials may improve clinical outcomes. Methods In this study, we sequenced a full draft assembly of the Balamuthia mandrillaris genome (44.2 Mb in size) from a rare survivor of PAM, and recovered the mitochondrial genome from six additional Balamuthia strains. We also used unbiased metagenomic next-generation sequencing (NGS) and SURPI bioinformatics analysis to diagnose an ultimately fatal case of Balamuthia mandrillaris encephalitis in a 15-year-old girl. Results and Discussion Comparative analysis of the mitochondrial genome and high-copy number genes from six additional Balamuthia mandrillaris strains demonstrated remarkable sequence variation, and the closest Balamuthia homologs corresponded to other amoebae, hydroids, algae, slime molds, and peat moss. Real-time NGS testing of hospital day 6 CSF and brain biopsy samples detected Balamuthia on the basis of high-quality hits to 16S and 18S ribosomal RNA sequences present in the National Center for Biotechnology Information (NCBI) nt reference database. The presumptive diagnosis of PAM by visualization of amoebae on brain biopsy histopathology and NGS analysis was subsequently confirmed at the US Centers for Disease Control and Prevention (CDC) using a Balamuthia-specific PCR assay. Retrospective analysis of a day 1 CSF sample revealed that more timely identification of Balamuthia by metagenomic NGS, potentially resulting in a better clinical outcome, would have required availability of the complete genome sequence. Conclusions These results underscore the diverse evolutionary origins of Balamuthia mandrillaris, provide new targets for diagnostic assay development, and will facilitate further investigations of the biology and pathogenesis of this eukaryotic pathogen. The failure to identify PAM from a day 1 sample without a fully sequenced Balamuthia genome in the database highlights the critical importance of whole-genome reference sequences for microbial detection by metagenomic NGS. Electronic supplementary material The online version of this article (doi:10.1186/s13073-015-0235-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander L Greninger
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Kevin Messacar
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Samia N Naccache
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Scot Federman
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Jerome Bouquet
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - David Mirsky
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Yosuke Nomura
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Shigeo Yagi
- California Department of Public Health, Richmond, CA, USA
| | | | | | - Craig A Press
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Samuel R Dominguez
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA. .,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA. .,Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, 94107, USA.
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Affiliation(s)
- Roy W R Dudley
- Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, QC, Canada.
| | - Christiana Smith
- Department of Infectious Diseases, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
| | - Megan Dishop
- Department of Pathology, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
| | - David Mirsky
- Department of Radiology, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
| | - Michael H Handler
- Department of Neurosurgery, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
| | - Suchitra Rao
- Department of Infectious Diseases, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA; Department of Hospital Medicine, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA
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Samiee S, Berardi P, Bouganim N, Vandermeer L, Arnaout A, Dent S, Mirsky D, Chasen M, Caudrelier JM, Clemons M. Excision of the primary tumour in patients with metastatic breast cancer: a clinical dilemma. ACTA ACUST UNITED AC 2012; 19:e270-9. [PMID: 22876156 DOI: 10.3747/co.19.974] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Approximately 10% of new breast cancer patients will present with overt synchronous metastatic disease. The optimal local management of those patients is controversial. Several series suggest that removal of the primary tumour is associated with a survival benefit, but the retrospective nature of those studies raises considerable methodologic challenges. We evaluated our clinical experience with the management of such patients and, more specifically, the impact of surgery in patients with synchronous metastasis. METHODS We reviewed patients with primary breast cancer and concurrent distant metastases seen at our centre between 2005 and 2007. Demographic and treatment data were collected. Study endpoints included overall survival and symptomatic local progression rates. RESULTS The 111 patients identified had a median follow-up of 40 months (range: 0.6-71 months). We allocated the patients to one ot two groups: a nonsurgical group (those who did not have breast surgery, n = 63) and a surgical group (those who did have surgery, n = 48, 29 of whom had surgery before the metastatic diagnosis). When compared with patients in the nonsurgical group, patients in the surgical group were less likely to present with T4 tumours (23% vs. 35%), N3 nodal disease (8% vs. 19%), and visceral metastasis (67% vs. 73%). Patients in the surgical group experienced longer overall survival (49 months vs. 33 months, p = 0.01) and lower rates of symptomatic local progression (14% vs. 44%, p < 0.001). CONCLUSIONS In our study, improved overall survival and symptomatic local control were demonstrated in the surgically treated patients; however, this group had less aggressive disease at presentation. The optimal local management of patients with metastatic breast cancer remains unknown. An ongoing phase iii trial, E2108, has been designed to assess the effect of breast surgery in metastatic patients responding to first-line systemic therapy. If excision of the primary tumour is associated with a survival benefit, then the preselected subgroup of patients who have responded to initial systemic therapy is the desired population in which to put this hypothesis to the test.
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Affiliation(s)
- S Samiee
- Division of Radiation Oncology, University of Ottawa and The Ottawa Hospital Cancer Centre, Ottawa, ON
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Samiee S, Berardi P, Bouganim N, Vandermeer L, Arnaout A, Mirsky D, Dent S, Caudrelier JM, Chasen M, Clemons M. P2-15-05: Excision of the Primary Tumour in Patients with Metastatic Breast Cancer – Will E2108 Provide the Definitive Answer? Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-15-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Approximately 10% of new breast cancer patients will present with overt synchronous metastatic disease. Controversy exists about the optimal local management of these patients. While several series suggest that removal of primary tumour is associated with a survival benefit, the retrospective nature of these studies raises considerable methodological challenges. We decided to evaluate the experience at our centre around the impact of surgery in patients with synchronous metastasis.
Method: Case records of all patients seen with primary breast cancer and concurrent distant metastases between 2005 to 2007 were reviewed. Demographic and treatment data was collected. The study endpoints compared both overall survival and symptomatic local progression rates between patients who had breast surgery and those who did not.
RESULTS: 111 patients were identified. Median follow-up 40 months (0.6-71 months). Patients were divided into two groups: those patients who underwent breast surgery (n=48; 29/48 had surgery immediate prior to metastatic diagnosis) and those that did not have surgery(n = 63). The surgical group were less likely to present with T4 tumours (20% vs 36%), N3 nodal disease (8% vs 19%) and visceral metastasis (67% vs 73%)when compared with non-surgical group. Improved overall survival (49 months vs 33 months; p=0.01) and less symptomatic local progression rates ( 15% vs 43%, p < 0.001 ) were seen in the surgical group compared to the non-surgical group.
CONCLUSIONS: The optimal local management of patients with metastatic breast cancer is unknown. Despite the surgery group demonstrating an improved overall survival and symptomatic local control, this group had less aggressive disease at presentation. These results confirm the need for prospective randomized studies. E2108, an ongoing Phase III Trial, was designed to assess the effect of breast surgery in metastatic patients responding to first line systemic therapy. If excision of the primary tumour is associated with a survival benefit, then the pre-selected subgroup of patients that have responded to initial systemic therapy is the desired population to put this hypothesis to test.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-05.
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Affiliation(s)
- S Samiee
- 1Ottawa General Cancer Centre, Ottawa, ON, Canada
| | - P Berardi
- 1Ottawa General Cancer Centre, Ottawa, ON, Canada
| | - N Bouganim
- 1Ottawa General Cancer Centre, Ottawa, ON, Canada
| | - L Vandermeer
- 1Ottawa General Cancer Centre, Ottawa, ON, Canada
| | - A Arnaout
- 1Ottawa General Cancer Centre, Ottawa, ON, Canada
| | - D Mirsky
- 1Ottawa General Cancer Centre, Ottawa, ON, Canada
| | - S Dent
- 1Ottawa General Cancer Centre, Ottawa, ON, Canada
| | | | - M Chasen
- 1Ottawa General Cancer Centre, Ottawa, ON, Canada
| | - M Clemons
- 1Ottawa General Cancer Centre, Ottawa, ON, Canada
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Paquet L, Verma S, Collins B, Song X, Wheatley-Price P, Hopkins S, Segal R, Dent S, Mirsky D, Goel R, Young V, Clemons M, Keller O, Chinneck A, Young R, Bedard M. P4-15-01: High Prevalence of Prospective Memory (PM) Impairment in Early Breast Cancer (EBC) Survivors within 1 Year of Adjuvant Chemotherapy Completion: Novel Findings Concerning Post Chemotherapy Cognitive Effects. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-15-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Numerous studies have demonstrated that EBC survivors report more memory problems than healthy controls. However, evidence of impairment on objective tests of memory remains inconclusive. Past research has focussed exclusively on retrospective memory (remembering information from the past when asked to do so), but the complaints of EBC patients appear better described as “prospective memory” failures defined as forgetting to carry out in the future previously formed intentions. The effective performance of many day-to-day activities relies on PM and its impairment has negative consequences in everyday life. Despite its high ecological relevance, no study has evaluated PM functioning in EBC survivors. Consequently, we assessed the prevalence of PM impairment among EBC survivors in the year following completion of chemotherapy. Methods We undertook a cross sectional quantitative case-control study aiming to recruit 80 patients from the Ottawa Hospital Regional Cancer Centre and 80 matched healthy controls from the community. Patients were within 1 year of having completed a first course of chemotherapy. A standardized test of prospective memory (Memory for Intention Screening Test) was administered to both groups. Following the International Cognition and Cancer Task Force recommendation (2008), impairment was defined as a score that fell one standard deviation below the mean performance of the control group. Standardized measures of depression (CESD), anxiety (STAI) and fatigue (Fact-F) were also completed. Results Data are available on 36 patients and 18 controls. Age was well balanced between the groups (case-control mean age 54y vs. 51y, respectively, p=.204). Overall PM impairment was observed in 41% of the participants. More importantly, the rate of PM impairment was significantly higher in the EBC group than controls (53% vs 17%; p < 0.005; odds ratio = 5.588; 95% CI=1.376 to 22.7). Multivariate logistic regression showed that PM performance was unaffected by age (p=0.459), depression (p=0.358), anxiety (p=0.512) or fatigue (p=0.595). Conclusions These preliminary findings provide further support for the hypothesis that breast cancer treatment can impair cognitive processes and yield new and important insights into the type of memory problems experienced by EBC survivors. They suggest that a significant proportion of patients exhibit deficits in PM, an aspect of memory involved in effective daily functioning. Our results also suggest that emotional distress and fatigue do not contribute to PM functioning. Further studies in this area should be directed at understanding the severity and duration of PM impairment. Acknowledging and studying this vexing problem in EBC survivors will aid in developing appropriate rehabilitation strategies.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-15-01.
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Affiliation(s)
- L Paquet
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - S Verma
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - B Collins
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - X Song
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - P Wheatley-Price
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - S Hopkins
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - R Segal
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - S Dent
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - D Mirsky
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - R Goel
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - V Young
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - M Clemons
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - O Keller
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - A Chinneck
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - R Young
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - M Bedard
- 1Carleton University, Ottawa, ON, Canada; The Ottawa Hospital Cancer Center, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
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Samiee S, Berardi P, Bouganim N, Vandermeer L, Arnaout A, Mirsky D, Dent S, Caudrelier J, Chasen MR, Clemons M. Does removal of the primary tumor in patients with metastatic breast cancer improve either local control or overall survival? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Grunfeld E, Julian J, Levine M, Pritchard K, Coyle D, Dent S, Verma S, Mirsky D, Sawka C, Ginsburg D, Wood M. A randomized controlled trial (RCT) of long-term follow-up for early stage breast cancer comparing family physician to specialist care: A report of secondary outcomes. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6003 Background: Breast cancer patients usually receive follow-up in specialist cancer clinics. We have reported that family physician follow-up of breast cancer patients is a safe and acceptable alternative to specialist follow-up as measured by the primary clinical outcome of the rate of serious clinical events (Grunfeld et al, JCO 2006;24(6)). We report here the secondary outcomes of this trial: quality of life domains, patient satisfaction and patients’ costs. Methods: Women with early stage breast cancer who had completed adjuvant therapy (patients may have continued on adjuvant hormonal therapy), who were disease free and between 9 and 15 months after diagnosis, were allocated to receive follow-up in a cancer clinic according to usual practice (CC arm) or follow-up from their own family physician (FP arm). For patients without recurrence, quality of life (QL) measured by the SF36, patient satisfaction, and patients’ costs were measured every 6 months. For patients with recurrence QL measured by the EORTC QLQ C-30 was measured at the time of recurrence. Results: 483 patients were allocated to the FP arm and 485 to the CC arm. Median follow-up was 3.5 years. There were no significant differences between groups on change scores for SF36 subscales to 24 months, or EORTC functional subscale scores at the time of recurrence. Patients’ costs of follow-up (travel costs, out-of-pocket expenses, and lost earnings) were significantly less to 24 months (p < 0.02) in the FP arm. Although costs were less between 36 and 48 months, these were not significant. Conclusions: Family physician follow-up of breast cancer patients does not have a negative impact on clinical or QL outcomes and is less costly for patients. No significant financial relationships to disclose.
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Affiliation(s)
- E. Grunfeld
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - J. Julian
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - M. Levine
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - K. Pritchard
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - D. Coyle
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - S. Dent
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - S. Verma
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - D. Mirsky
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - C. Sawka
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - D. Ginsburg
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - M. Wood
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Queen’s University, Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
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Abujudeh H, Mirsky D. Traumatic high-flow priapism: treatment with super-selective micro-coil embolization. Emerg Radiol 2005; 11:372-4. [PMID: 16151866 DOI: 10.1007/s10140-005-0404-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 12/20/2004] [Indexed: 11/29/2022]
Affiliation(s)
- Hani Abujudeh
- Radiology Department, University of Medicine and Dentistry of New Jersey, 150 Bergen Street, Newark, NJ 07103, USA.
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Grunfeld E, Levine M, Julian J, Pritchard K, Coyle D, Mirsky D, Verma S, Dent S, Sawka C, Ginsburg D. A randomized controlled trial (RCT) of routine follow-up for early stage breast cancer: A comparison of primary care versus specialist care. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Grunfeld
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
| | - M. Levine
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
| | - J. Julian
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
| | - K. Pritchard
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
| | - D. Coyle
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
| | - D. Mirsky
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
| | - S. Verma
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
| | - S. Dent
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
| | - C. Sawka
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
| | - D. Ginsburg
- Cancer Care Nova Scotia, Halifax, NS, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada; Ottawa Regional Cancer Centre, Ottawa, ON, Canada; Kingston Regional Cancer Centre, Kingston, ON, Canada
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Mai KT, Chaudhuri M, Perkins DG, Mirsky D. Resection margin status in lumpectomy specimens for duct carcinoma of the breast: correlation with core biopsy and mammographic findings. J Surg Oncol 2001; 78:189-93. [PMID: 11745804 DOI: 10.1002/jso.1147] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The strategy for surgical treatment of breast carcinoma proven by biopsy is mainly based on the physical and mammographic examinations. To investigate if the pathological findings in core biopsy are contributory to planning the surgical strategy, we correlated the status of ductal carcinoma in situ (DCIS) in the core needle biopsy of breast, the mammographic changes and the status of resection margins in the subsequent lumpectomy. STUDY DESIGN Consecutive 130 core needle biopsies with prior mammography and subsequent lumpectomy were reviewed. Biopsies were divided into: group I, DCIS; group II, DCIS and infiltrating carcinoma (IC); and group III, IC. Mammographic findings were categorized into four groups: (a) nonspecific findings; (b) calcification (Ca(++)); Ca(++) and mass, and mass only. The status of margins in correlating lumpectomy specimens was reviewed. Close margin was defined as a free margin at less than 0.1cm from the carcinoma. RESULTS The rates of positive or close margins in three groups I, II, and III were 13/18, 18/48, and 2/64 (P < 0.001); and in mammography groups of nonspecific finding, Ca(++), Ca(++) mass and mass only were 5/6, 7/15, 8/37, and 13/72 (P < 0.001), respectively. Of the total of 14 cases with positive margins of more than 0.5 cm in length, 8, 4, and 2 cases were from group I, II, and II, respectively. In addition, 13 of 21 cases with nonspecific changes or with only Ca(++) in mammograms belonged to the group I; 10 of these 13 cases were associated with positive margins. Forty-one of 72 cases presenting as a mass only in mammograms belonged to the group III; only 2 of these 41 cases were associated positive margins. CONCLUSIONS Correlation of the extent of carcinoma with pre-operative histopathological findings was better than with mammography. Core biopsies containing only DCIS, particularly in cases with nonspecific findings or with only Ca(++) in mammograms, represent a group of breast carcinoma that pose the high risk for incomplete resection in lumpectomy. Surgical management of patients having these cores includes wider resection margins than would otherwise be taken. Most core biopsies with only IC were associated with negative margins.
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Affiliation(s)
- K T Mai
- Division of Anatomical Pathology, Department of Laboratory Medicine, The Ottawa Hospital, Civic Campus, University of Ottawa, Ottawa, Ontario, Canada.
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Mai KT, Yazdi HM, Burns BF, Perkins DG, Mirsky D. Proposed technique for sectioning of mastectomy specimens and submission of tissue for microscopic examination of breast carcinoma. Histopathology 2001; 39:325-7. [PMID: 11532046 DOI: 10.1046/j.1365-2559.2001.1181d.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Olivotto IA, Bancej C, Goel V, Snider J, McAuley RG, Irvine B, Kan L, Mirsky D, Sabine MJ, McGilly R, Caines JS. Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces. CMAJ 2001; 165:277-83. [PMID: 11517642 PMCID: PMC81326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Delay to breast cancer diagnosis following an abnormal screening result is associated with anxiety and personal disruption. We assessed the patterns and timeliness of diagnostic follow-up after breast cancer screening for women with abnormal results who attended organized screening programs in 7 provinces. METHODS Using data from the Canadian Breast Cancer Screening Database, we identified 203,141 women aged 50-69 years who underwent screening in 1996 through provincially organized breast cancer screening programs in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia and Newfoundland. We prospectively followed women with an abnormal screening result through to the completion of the assessment process. We evaluated the waiting times from screening examination to first assessment, from screening examination to first imaging, from screening examination to diagnosis and from first assessment to diagnosis for 13,958 women, stratified according to screening program, mode of detection, whether a biopsy was performed and whether cancer was diagnosed. RESULTS We observed considerable variations between and within programs in the time to diagnosis. The median time from screening examination to first assessment was 2.6 weeks. The median time from screening examination to diagnosis was 3.7 weeks; this time increased to 6.9 weeks for women undergoing biopsy. Even when no biopsy was performed, 10% of the women waited 9.6 weeks or longer for a diagnosis, as compared with 15.0 weeks or longer for 10% of the women undergoing biopsy. Among the women who had a biopsy, the use of core biopsy was associated with a shorter median time to diagnosis than was open biopsy, and those found to have cancer had shorter waiting times than women with benign biopsy findings. INTERPRETATION Women undergoing assessment of an abnormal breast cancer screening result waited many weeks for a diagnosis, especially when a biopsy was performed. To ensure that targets for timeliness, adopted nationally in 1999, are realized, improved models of care or dissemination of existing efficient techniques to reach a diagnosis will be needed.
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Affiliation(s)
- I A Olivotto
- Division of Radiation Oncology, University of British Columbia, Vancouver, BC
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